Individual
PETER NIEMCZYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5171 CUB LAKE RD, BLDG C STE 340, SHOW LOW, AZ 85901-7888
(928) 537-0111
(623) 582-9666
Mailing address
20325 N 51ST AVE, #102, GLENDALE, AZ 85308-5674
(623) 780-2300
(623) 582-9666
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
34718
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z2716
HEALTHNET
AZ
05
—
477100
—
AZ
01
—
5135633
AETNA
—
01
—
674661
CIGNA
—
01
—
AZ0156450
BLUE CROSS BLUE SHIELD
AZ
01
—
P00378324
RAILROAD MEDICARE
—
Enumeration date
09/20/2005
Last updated
05/21/2010
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